Ultrasound-guided ankle block: An attractive anaesthetic technique for foot surgery
Keywords:
Anesthesia, Nerve block, Ankle, General surgery, Anesthesia conduction, Ultrasonography
Abstract
Foot innervation, defined as distal to the tibial and fibular malleoli, is provided by five nerves, namely the tibial, peroneal (deep and superficial), sural and saphenous nerves. Blockade of these nerves is referred to as ankle block. The main advantage of using this block in foot surgery over other regional techniques is the absence of motor blockade above the ankle, which allows faster mobility after surgery. The use of ultrasound for this block has been shown to be of higher clinical efficacy when compared to a landmark approach. The purpose of this continuing education article is not only to detail the anatomy and sonoanatomy of the five nerves innervating the foot, but the ultrasound technique as well. The ultrasound-guided ankle block can be used alone as anaesthetic technique or as adjuvant for analgesia in foot surgery.
References
1. Collins L, Halwani A, Vaghadia H. Impact of a regional anesthesia analgesia program for outpatient foot surgery. Can J Anaesth. 1999;46:840-5.
2. Chelly JE, Greger J, Casati A, Al-Samsam T, McGarvey W, Clanton T. Continuous lateral sciatic blocks for acute postoperative pain management after major ankle and foot surgery. Foot Ankle Int. 2002;23:749-52.
3. Pearce CJ, Hamilton PD. Current concepts review: regional anesthesia for foot and ankle surgery. Foot Ankle Int. 2010;31:732-9.
4. Peng PWH. Ultrasound for pain medicine intervention: a practical guide. Vol. I: Peripheral structures. Philip Peng education series (electronic book); 2012.
5. Vadivelu N, Kai AM, Maslin B, Kodumudi V, Antony S, Blume P. Role of regional anesthesia in foot and ankle surgery. Foot Ankle Spec. 2015;8:212-9.
6. Purushothaman L, Allan AG, Bedforth N. Ultrasound-guided ankle block. Contin Educ Anaesth Crit Care Pain. 2013;13:174-8.
7. Fredrickson MJ. Ultrasound-guided ankle block. Anaesth Intensive Care. 2009;37:143-4.
8. Migues A, Slullitel G, Vescovo A, Droblas F, Carrasco M, Perrin 17. Turenne H. Peripheral foot blockade versus popliteal fossa nerve block: a prospective randomized trial in 51 patients. J Foot Ankle Surg. 2005;44:354-7.
9. Tryba M. Ankle block: a safe and simple technique for foot surgery. Curr Opin Anaesthesiol. 1997;10:361-5.
10. Lee TH, Wapner KL, Hecht PJ, Hunt PJ. Regional anesthesia in foot and ankle surgery. Orthopedics. 1996;19:577-80.
11. Rudkin GE, Micallef TA. Impediments to the use of ankle block in Australia. Anaesth Intensive Care. 2004;32:368-71.
12. Chin KJ, Wong NWY, Macfarlane AJR, Chan VWS. Ultrasound-guided versus anatomic landmark-guided ankle 21. blocks: a 6-year retrospective review. Reg Anesth Pain Med. 2011;36:611-8.
13. Lopez AM, Sala-Blanch X, Magaldi M, Poggio D, Asuncion J, Franco CD. Ultrasound-guided ankle block for forefoot 22. surgery: the contribution of the saphenous nerve. Reg Anesth Pain Med. 2012;37:554-7.
14. Peer S, Gruber H. Atlas of peripheral nerve ultrasound. Berlin: Springer; 2013.
15. Redborg KE, Antonakakis JG, Beach ML, Chinn CD, Sites BD. Ultrasound improves the success rate of a tibial nerve block at the ankle. Reg Anesth Pain Med. 2009;34:256-60.
16. Lin E, Gaur A, Jones M, Ahmed A. Sonoanatomy for anesthetists. United Kingdom: Cambridge University Press; 2012.
17. Canella C, Demondion X, Guillin R, Boutry N, Peltier J, Cotten A. Anatomic study of the superficial peroneal nerve using sonography. AJR Am J Roentgenol. 2009;193:174-9.
18. Chin KJ. Ultrasound visualization of the superficial peroneal nerve in the mid-calf. Anesthesiology. 2013;118:956-65.
19. Lawrence SJ. The deep peroneal nerve in the foot and ankle: an anatomic study. Foot Ankle Int. 1995;16:724-8.
20. Antonakakis J, Scalzo DC, Jorgenson AS, Figg KK, Ting P, Zuo Z, et al. Ultrasound does not improve the success rate of a deep peroneal nerve block at the ankle. Reg Anesth Pain Med. 2010;35:217-21.
21. Redborg KE, Sites BD, Chinn CD, Gallagher JD, Ball PA, Antonakakis JG, et al. Ultrasound improves the success rate of a sural nerve block at the ankle. Reg Anesth Pain Med. 2009;34:24-8.
22. Chen J, Lesser J, Hadzic A, Resta-Flarer F. The importance of the proximal saphenous nerve block for foot and ankle surgery. Letter to the Editor. Reg Anesth Pain Med. 2013;38: 372.
23. De Mey JC, Deruyck LJ, Cammu G, De Baerdemaeker LE, Mortier EP. A paravenous approach for the saphenous nerve block. Reg Anesth Pain Med. 2001;26:504-50.
24. Fredrickson MJ, White R, Danesh-Clough TK. Low-volume ultrasound-guided nerve block provides inferior postoperative analgesia compared to a higher-volume landmark technique. Reg Anesth Pain Med. 2011;36:393-8.
2. Chelly JE, Greger J, Casati A, Al-Samsam T, McGarvey W, Clanton T. Continuous lateral sciatic blocks for acute postoperative pain management after major ankle and foot surgery. Foot Ankle Int. 2002;23:749-52.
3. Pearce CJ, Hamilton PD. Current concepts review: regional anesthesia for foot and ankle surgery. Foot Ankle Int. 2010;31:732-9.
4. Peng PWH. Ultrasound for pain medicine intervention: a practical guide. Vol. I: Peripheral structures. Philip Peng education series (electronic book); 2012.
5. Vadivelu N, Kai AM, Maslin B, Kodumudi V, Antony S, Blume P. Role of regional anesthesia in foot and ankle surgery. Foot Ankle Spec. 2015;8:212-9.
6. Purushothaman L, Allan AG, Bedforth N. Ultrasound-guided ankle block. Contin Educ Anaesth Crit Care Pain. 2013;13:174-8.
7. Fredrickson MJ. Ultrasound-guided ankle block. Anaesth Intensive Care. 2009;37:143-4.
8. Migues A, Slullitel G, Vescovo A, Droblas F, Carrasco M, Perrin 17. Turenne H. Peripheral foot blockade versus popliteal fossa nerve block: a prospective randomized trial in 51 patients. J Foot Ankle Surg. 2005;44:354-7.
9. Tryba M. Ankle block: a safe and simple technique for foot surgery. Curr Opin Anaesthesiol. 1997;10:361-5.
10. Lee TH, Wapner KL, Hecht PJ, Hunt PJ. Regional anesthesia in foot and ankle surgery. Orthopedics. 1996;19:577-80.
11. Rudkin GE, Micallef TA. Impediments to the use of ankle block in Australia. Anaesth Intensive Care. 2004;32:368-71.
12. Chin KJ, Wong NWY, Macfarlane AJR, Chan VWS. Ultrasound-guided versus anatomic landmark-guided ankle 21. blocks: a 6-year retrospective review. Reg Anesth Pain Med. 2011;36:611-8.
13. Lopez AM, Sala-Blanch X, Magaldi M, Poggio D, Asuncion J, Franco CD. Ultrasound-guided ankle block for forefoot 22. surgery: the contribution of the saphenous nerve. Reg Anesth Pain Med. 2012;37:554-7.
14. Peer S, Gruber H. Atlas of peripheral nerve ultrasound. Berlin: Springer; 2013.
15. Redborg KE, Antonakakis JG, Beach ML, Chinn CD, Sites BD. Ultrasound improves the success rate of a tibial nerve block at the ankle. Reg Anesth Pain Med. 2009;34:256-60.
16. Lin E, Gaur A, Jones M, Ahmed A. Sonoanatomy for anesthetists. United Kingdom: Cambridge University Press; 2012.
17. Canella C, Demondion X, Guillin R, Boutry N, Peltier J, Cotten A. Anatomic study of the superficial peroneal nerve using sonography. AJR Am J Roentgenol. 2009;193:174-9.
18. Chin KJ. Ultrasound visualization of the superficial peroneal nerve in the mid-calf. Anesthesiology. 2013;118:956-65.
19. Lawrence SJ. The deep peroneal nerve in the foot and ankle: an anatomic study. Foot Ankle Int. 1995;16:724-8.
20. Antonakakis J, Scalzo DC, Jorgenson AS, Figg KK, Ting P, Zuo Z, et al. Ultrasound does not improve the success rate of a deep peroneal nerve block at the ankle. Reg Anesth Pain Med. 2010;35:217-21.
21. Redborg KE, Sites BD, Chinn CD, Gallagher JD, Ball PA, Antonakakis JG, et al. Ultrasound improves the success rate of a sural nerve block at the ankle. Reg Anesth Pain Med. 2009;34:24-8.
22. Chen J, Lesser J, Hadzic A, Resta-Flarer F. The importance of the proximal saphenous nerve block for foot and ankle surgery. Letter to the Editor. Reg Anesth Pain Med. 2013;38: 372.
23. De Mey JC, Deruyck LJ, Cammu G, De Baerdemaeker LE, Mortier EP. A paravenous approach for the saphenous nerve block. Reg Anesth Pain Med. 2001;26:504-50.
24. Fredrickson MJ, White R, Danesh-Clough TK. Low-volume ultrasound-guided nerve block provides inferior postoperative analgesia compared to a higher-volume landmark technique. Reg Anesth Pain Med. 2011;36:393-8.
How to Cite
1.
Girón-Arango L, Vásquez-Sadder MI, González-Obregón MP, Gamero-Fajardo CE. Ultrasound-guided ankle block: An attractive anaesthetic technique for foot surgery. Colomb. J. Anesthesiol. [Internet]. 2015 Oct. 1 [cited 2024 Apr. 23];43(4):283–289. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/340
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Published
2015-10-01
How to Cite
1.
Girón-Arango L, Vásquez-Sadder MI, González-Obregón MP, Gamero-Fajardo CE. Ultrasound-guided ankle block: An attractive anaesthetic technique for foot surgery. Colomb. J. Anesthesiol. [Internet]. 2015 Oct. 1 [cited 2024 Apr. 23];43(4):283–289. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/340
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